new clients

If you are interested in scheduling your first appointment with me, you can either fill out the Request 1st Appointment form or email me at:  jjbutler13@gmail.com.

If you have already had your initial telephone call with me and have your first appointment scheduled, then you will need to fill out the New Client Forms prior to your first visit. You can fill out the online New Client Forms and they will be submitted to me automatically or you can click the links below to print them, fill them out and then scan/email them to me at jjbutler13@gmail.com

request 1st appointment

new client forms

Click here to fill out the online New Client Forms.



OR
​

Print, fill out and scan/email me the following forms:

 

Intake Form

Presenting Symptoms

Statement of Understanding

HIPAA Notice of Privacy Practices

3154 Mallard Cove Lane

Fort Wayne, IN  46804

   

(260) 436-5353

(260) 436-5399 Fax

Jocelyn J. Butler MSW, LCSW

Individual and Family Therapy

 

Day and evening office hours by appointment.